Attribution of Malnutrition to Cause-Specific Diarrheal Illness: Evidence from a Prospective Study of Preschool Children in Mirpur, Dhaka, Bangladesh

Dinesh Mondal International Centre For Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh; Department of International Health, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Unit of Infectious Diseases, University of Vermont College of Medicine, Burlington, Vermont; Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia

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Rashidul Haque International Centre For Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh; Department of International Health, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Unit of Infectious Diseases, University of Vermont College of Medicine, Burlington, Vermont; Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia

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R. Bradley Sack International Centre For Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh; Department of International Health, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Unit of Infectious Diseases, University of Vermont College of Medicine, Burlington, Vermont; Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia

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Beth D. Kirkpatrick International Centre For Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh; Department of International Health, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Unit of Infectious Diseases, University of Vermont College of Medicine, Burlington, Vermont; Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia

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William A. Petri Jr International Centre For Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh; Department of International Health, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Unit of Infectious Diseases, University of Vermont College of Medicine, Burlington, Vermont; Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia

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We examined whether malnutrition (underweight [WAZ] < −2) increased the risk of diarrhea equally for all enteropathogens. The study was conducted prospectively between January 1999 and July 2002 in Mirpur, an urban slum in Dhaka. Two hundred eighty-nine Bangladeshi children (147 male and 142 female) 2–5 years of age were included in the study. Malnutrition was present in 39% of the children at the time of enrollment. The parents and children were visited and interviewed every other day by health care workers for details about any diarrheal episodes. Stool samples were successfully collected from 62% of episodes of diarrhea. Of the identified enteropathogens, only enterotoxigenic Escherichia coli (ETEC), Cryptosporidium sp., and Entamoeba histolytica were significantly more prevalent in malnourished children. We concluded that the malnutrition attributed risk is not equal for enteric pathogens associated with diarrheal illness.

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